Assessment of Sensory Processing Characteristics in Children Between 0 and 14 Years of Age: A Systematic Review

Objectives processing disorder (SPD) is a neurodevelopmental disorder that can negatively affect objective, emotional, and behavioral functioning. Therefore, assessing sensory processing is critical in children. This study aimed to provide a current comprehensive list of assessment instruments special about sensory processing in children aged between 0 and 14 years. Materials & Methods This systematic review focused on pediatric assessment of sensory processing. Three electronic databases (Google Scholar, Web of Science, Scopus, PubMed, and ProQuest) were comprehensively searched for eligible studies, and language restriction (English) was applied. The search strategy consisted of keywords and medical subordinate headings for sensory processing and various pediatric assessment tools. Results Thirty-four assessment tools were identified, of which nine met the predefined inclusion criteria. The test of ideational praxis, clinical observations of proprioception, and pediatric clinical test of sensory interaction for balance were clinical observational assessment tools. The final tool was a caregiver or teacher reported questionnaire. The obtained studies evaluated the clinical use and psychometric properties of these nine assessment tools. Conclusion The result of this study indicated that each of the sensory processing assessment tools considered various aspects of sensory processing. Selecting the most appropriate assessment tools to measure sensory processing function in children depends on specific components of sensory processing that need to be evaluated.


Introduction
"Sensory processing is defined as registration, modulation, integration, and organization of sensory inputs to execute successful adaptive responses to situational demands, and in this way, engage meaningfully in daily occupations (1)". The defect in this process leads to sensory processing disorder (SPD). SPD expresses dysfunctions in the capacity to regulate and organize the degree, intensity, and nature of responses to sensory inputs in a graded and adaptive manner. These disorders have a long-term impact on a child's life at home, at school, and in the community (2). notice and react to stimuli more often because their neurological system activates more easily and responds more readily to sensory events. On the other hand, people with a high sensory threshold often miss stimuli that others notice easily because their neurological system needs stronger stimuli to be activated. Self-regulation is a continuum of a behavioral construct. One end shows those who produce a passive strategy toward sensory events, like remaining at a place with many sensory inputs that makes them feel uncomfortable and respond with disappointment. The other end indicates people that use an active approach; for example, adjusting one's position to influence a manageable amount of sensory inputs. Accordingly, four patterns can result from the intersection of the neurological threshold and self-regulation; they are (1) registration (represents high neurological thresholds with passive self-regulation), (2) seeking (represents high neurological thresholds as well, but seekers have an active self-regulation strategy and generate new ideas), (3) sensitivity (represents low neurological thresholds and a passive self-regulation strategy, and (4)  Functional impairments associated with SPD include decreased social skills, decreased collaboration in daily practice, lack of adaptive responses, impaired self-confidence or selfesteem, diminished fine and gross motor skill development; delay in learning and language, and decreased executive and self-regulatory function.
These factors demonstrate why sensory processing is recognized as a domain of concern in the pediatric field (5,6,7). assessment for children with SPD (7,8). This study aimed to provide a current comprehensive list of pediatric assessment tools particularly developed for sensory processing in children between 0 and 14 years of age. This systematic review summarizes the psychometric characteristics of the tools evaluating sensory processing. Based on the result of our review, professionals can use suitable and valid sensory processing assessment tools fundamental to identifying and optimizing sensory processing in SPD patients.

Review question
1. What tools are available for assessing sensory processing in SPD patients?

Materials & Methods
This study was designed as a review for running overall reported assessment tools for sensory processing in the past 29

Bibliographic database searches
The search strategy included MeSH databases, and text words included: ("child behavior" OR "sensation" OR "psychomotor performance" OR "sensory processing" OR "perception" OR "sensorial modulation" OR "sensation disorder") AND ("psychometrics" OR "outcome assessment" OR "questionnaire" OR outcome and process assessment") AND ("pediatrics" OR "child"). The PubMed search strategy shown in Table 1 was adapted for the other databases.

Inclusion criteria
Articles were reviewed if they met all the following inclusion criteria: (1) being used to assess sensory processing in children; (2)  auditory processing, vestibular processing, proprioceptive processing, smell processing, and tactile processing).

Exclusion criteria
Articles were excluded if they met any of the following exclusion criteria: (1) being predominately a child behavior measure; (2) being a communication or cognitive test; (3) being an informal test; (4) being published before 1990; (5) having subjects with the age greater than 14 years, and (6) having tools with the focus mainly on motor skills.

Bias avoidance
To avoid bias, extraction and quality evaluation of published articles were properly performed by two academic researchers. If the articles were rejected, the reason for their refusal was mentioned and any disagreement between the two authors was solved with discussion.
methodological quality assessment and data report The methodological quality of the included articles was assessed using the can child outcome measure rating form.

Data extraction
After excluding articles, the full texts of the remaining articles were carefully studied.

Results
In this study, 38 articles were selected and after reviewing their full texts, they were assessed for eligibility. Finally, 25 articles were excluded. Table   2 lists the 25 articles that were excluded based on the inclusion and exclusion criteria.

Interpretation of scores
The standard score for each scale enables classification of child functioning into one of five interpretive ranges: Much less than others, less than others, same as others, more than others, and much more than others.     There are many tools for evaluating sensory processing in the first 14 years of life; nevertheless, we recommend professionals, particularly occupational therapists, to use the sensory profile 2. Reasons for using this tool are as follows: • It has a broad age range (birth to 14:11).
• It has various administration options (paper and pencil or online through Q-global™).
• It includes a set of separate questionnaires related to age and various contexts (the infant, toddler, child, short, and school sensory profile 2).
• It considers broad domains (sensory system, behavioral pattern, sensory pattern, and school factors).
• Among the tools reviewed in this study, the highest sample size (1791 typical and atypical children) was used in the psychometric study of the test.
• It identifies behaviors that children exhibit as sensory processing patterns. It is based on a conceptual structure that proposes an interaction between neurological thresholds and selfregulatory behavioral responses, initially described by Dunn (1997

Author`s Contribution
Marjan Shahbazi: contributed to conception, design, data extraction, analysis and drafted this article, wrote the manuscript, and approved the final manuscript as submitted.
Navid Mirzakhani: contributed to conception, helped in literature review, and selected of study.